初探超声造影基于LI-RADS分类标准诊断肝细胞癌的可行性  

LI-RADS with contrast-enhanced ultrasound for diagnosis of hepatocellular carcinoma(HCC):apreliminary study

作　　者：沈若霞[1] 张圆[1] 邵晖[1] 年英华[1] 姚南[1] 王关顺[2] 

机构地区：[1]昆明医科大学第三附属医院云南省肿瘤医院超声科,昆明650118 [2]昆明医科大学第三附属医院云南省肿瘤医院放射科,昆明650118

出　　处：《放射学实践》2016年第4期311-315,共5页Radiologic Practice

基　　金：云南省教育厅基金(2014Y169);云南省科技厅-昆明医科大学应用基础研究联合专项基金(2014FB062;2015FB071)

摘　　要：目的：探讨基于肝脏影像报告和数据管理系统（LI-RADS）的超声造影检查诊断肝细胞癌（HCC）的可行性。方法：回顾性分析108例有肝癌高风险的单发肝脏病变患者的超声造影资料,并基于LI-RADS分类标准对肝脏病变进行分析评估,并与病理或临床诊断结果相对照。结果：108个病灶中LI-RADS 1~5类病灶共106个：1类和2类病灶19个,临床客观诊断结果均为良性（阴性预测值为100%）;3类病灶3个;22个4类病灶中17个为HCC（阳性预测值为77.3%）;62个5类病灶中有54个为HCC（阳性预测值为87.1%）。受试者工作特征（ROC）曲线下面积为0.83（P〈0.001）。若将LI-RADS 3~5类病灶归为阳性,基于LI-RADS的超声造影检查对HCC的诊断符合率为83.9%（92/106）,敏感度为100%（73/73）,特异度为57.6%（19/33）,阳性预测值为83.9%（73/87）,阴性预测值为100%（19/19）;若将LIRADS 3类病灶排除、1~2类病灶归为阴性、4~5类病灶归为阳性,则诊断符合率为87.4%（90/103）,敏感度为100%（71/71）,特异度为59.4%（19/32）,阳性预测值为84.5%（71/84）,阴性预测值为100%（19/19）。结论：超声造影检查中应用LI-RADS分类标准诊断HCC具有一定的可行性。Objective：To explore the feasibility of liver imaging reporting and data system（LI-RADS）with contrastenhanced ultrasound for diagnosis of hepatocellular carcinoma（HCC）.Methods：The contrast-enhanced ultrasound（CEUS）data of 108 patients at high risk of HCC were retrospectively analyzed using LI-RADS.The diagnostic results of CEUS were compared with the results of clinical objective diagnosis.Sensitivity,specificity,negative（NPV）and positive predictive values（PPV）,and receiver operating characteristic（ROC）curve were then produced.Results：108lesions were found by CEUS including 106 lesions in LI-RADS category 1~5：19lesions oincategory 1or 2were all benign（NPV=100%）;there were 3lesions in category 3;of 22 lesions in category 4,there were 17HCCs（PPV=77.3%）;of 62 lesions in category 5,there were 54HCCs（PPV=87.1%）.The area underneath the ROC curve was 0.83 with statistic significance（P0.001）.If category 1and 2were considered as negative and category 3~5were considered as positive,the accuracy,sensitivity,specificity,PPV and NPV of CEUS based on the LI-RADS classification for the diagnosis of HCC were 83.9%,100%,57.6%,83.9% and 100% respectively.If the lesions in category 3were excluded,and category 1and 2were considered as negative,category 4~5were considered as positive,the accuracy,sensitivity,specificity,PPV and NPV of CEUS based on the LI-RADS classification for diagnosis of HCC were 87.4%,100%,59.4%,84.5%and 100%respectively.Conclusion：Contrast-enhanced ultrasound based on LI-RADS is feasible for diagnosis of HCC.

关 键 词：肝脏影像报告和数据管理系统 肝肿瘤 肝细胞癌 超声成像 对比增强 诊断效能 

分 类 号：R445.1[医药卫生—影像医学与核医学] R735.7[医药卫生—诊断学]